Most Americans want to grow old in their homes, where they are most comfortable, not in a facility. But, because the US does not support paid caregiving, which is extremely costly, the job generally falls to family caregivers, which is challenging financially, emotionally and logistically. Michelle Cottle writes an opinion piece for The New York Times on the costly and too often lonely job of family caregiving.
With little if any help, about 42 million Americans care for an aging person, 50 and older. That is challenging work emotionally and financially. Because the US is an aging nation, more Americans will find themselves as unpaid caregivers needing support.
By AARP’s projections, unpaid family caregiving amounts to some $600 billion of free services in 2021. A lot of caregiving time can be spent commuting. The cost of not being able to work fulltime or at all drives some caregivers into bankruptcy. Caregivers forego a projected $522 billion a year in income.
Typically, 25 percent of caregivers’ income goes to helping with expenses of the people they are caring for, such as home modifications, medical bills and housing.
The stress too often causes declines in health, both mental and physical. Studies show that caregivers are more prone to suffer from depression and cancer and are more likely to die younger than people who are not caregivers.
We have no system in place to train caregivers to undertake their myriad responsibilities. As the health care system evolves and creates additional burdens on individuals, caregivers often must assume responsibility for providing treatment to their loved ones, such as caring for wounds, administering injections and taking care of IV lines. They must also tackle the myriad health insurance obstacles to care and coverage, generally without assistance.
Caregivers need to take a rest periodically. But, the cost of hiring caregivers can be extremely high. And, paid caregivers are few and far between in many communities.
The Biden Administration planned to invest $400 billion in strengthening home care, providing training for caregivers and ensuring they are paid well enough to want to take on the responsibilities. But, Congress ended up cutting these provisions out of the Build Back Better bill in 2022. The President’s current budget proposal calls for $150 billion in Medicaid home care services, but Republicans are unlikely to support it.
There are bills in Congress to support states in building a corps of trained caregivers. But, the cost of hiring caregivers is generally prohibitive. Medicare does not cover caregiver services except in very limited situations for short periods of time, under its home health benefit. It only covers care for people who are homebound and need skilled nursing or therapy services on an intermittent basis. And, even when it provides coverage, it is extremely limited, perhaps 12 hours a week.
Medicaid sometimes does pay for caregiving services. But, to qualify, in most states, you can have no more than $2,000 in assets (the value of your home and car are excluded). Moreover, many people with Medicaid are on long waitlists to get caregiving services at home.
Some states, such as Washington State, have their own long-term-care insurance program. Maine has a pilot program. About a quarter of the states have some paid family and medical leave or allow workers to use some of their sick time for caregiving.
Here’s more from Just Care:
